Health chief takes Illinois TB patient to court

Article by: CARLA K. JOHNSON

Associated Press

April 10, 2014 - 11:30 AM

CHICAGO — A central Illinois health official wants a judge to order an uncooperative patient with infectious tuberculosis to stay in his home and wear an electronic monitoring ankle bracelet to prevent the spread of disease.

Anyone attending the court hearing Friday in Champaign County will be required to wear a fitted face-mask respirator to protect against contracting the lung disease. The patient, Christian Mbemba Ibanda, has entertained visitors and left his home despite warnings, said Champaign-Urbana Public Health District Administrator Julie Pryde, who's seeking the court order. His close contacts already are getting TB tests to see if they need treatment.

"We had been telling this gentleman, 'Listen. We're not messing around,'" Pryde said. "This is a serious illness. You cannot be exposing other people." She said the patient needs to be isolated until three sputum samples test negative, which could take up to six weeks.

If the patient fails to comply with a court order, he could go to jail, Pryde said. The county sheriff has located a negative pressure cell in another county that could be used, she said.

Tuberculosis bacteria usually attack the lungs causing violent coughing, weight loss and chills. Without treatment, the disease can be fatal. Not everyone with TB bacteria gets sick and people with latent TB aren't infectious. But latent TB can turn into disease if the bacteria become active and multiply.

While taking a patient to court is a last resort, it is standard practice nationally among public health workers on the front lines against the looming threat of drug-resistant TB. In Illinois, there have been four such court actions in the past decade, said Illinois Department of Public Health spokeswoman Melaney Arnold.

"It's not anyone's first choice," said Dr. Georges Benjamin, executive director of the American Public Health Association. But local health departments provide treatment for the most difficult tuberculosis patients, including those with drug-resistant forms and those who don't comply with treatment. "The reason (for a court action) is to protect the public and hopefully to get the patient better."

In the United States, tuberculosis is on the decline, with fewer than 10,000 cases reported each year, including about 350 annually in Illinois. But TB kills more than 1 million people each year around the globe. Multi-drug resistant TB is surfacing in many countries increasing the risk of travelers bringing those varieties into the United States where they could cause an outbreak.

Fortunately, the uncooperative Illinois patient has a form of TB that responds to drug treatment, Pryde said, but until he's no longer infectious, he could spread the bacteria by coughing or sneezing.

Beating back infectious tuberculosis requires a proven but labor-intensive strategy called directly observed therapy, or DOT. It's a way to make sure patients take their medicine. Health care workers watch patients take their pills, visiting them in their homes.

"It's a very demanding and expensive process that creates a strain on the resources of the public health department," said Paul Etkind of the National Association of County and City Health Officials. Stopping and starting treatment can lead to drug resistance, another reason for public health workers to be aggressive in making sure patients take their pills, Etkind said.

Public health nurses who were trying to visit the Illinois patient found him away from home on multiple occasions. When they called his cellphone, he once said he was out shopping. On another visit, they found a woman and a 5-year-old girl there with him and not wearing masks.

Ibanda doesn't have a listed phone number. The Associated Press attempted to reach him at a phone number and an email for a similar name in Champaign and received no response.

Pryde said she hopes he shows up in court on Friday, but said the judge could act without him present.

"I want him to be medically isolated," Pryde said. "I don't want him to be vilified or ostracized."